Confused about BMI relevance 🤷‍♀️

[Lx990125]

Hi,
Looking for guidance about how worried I should be about my BMI when it comes to pregnancy. I have a very high BMI but I am not in any way obese, and would not be classed as this medically. I am sightly overweight but only by 1 or two dress sizes I am a size 12/14 in clothes. My weight is so high because I have size JJ breasts and from weighing them I know they take up at least 1.5 to 2 stones of my body weight. I know this puts my BMI at roughly around 30 which is classed as obese. I have read a lot of threads talking about obesity increasing the risk and the added dangers but what do I do if I am not medically obese but my BMI says I am. I am quite short and have an Afro carribean background which I know can affect the accuracy of BMI reading but I am currently awaiting a booking in appointment and I'm worries the midwife is going to tell me that I am at a high risk of losing my pregnancy and that it is my fault. I feel like there is nothing I can do, I already have tried to get reduction surgery and due to pregnancy cannot pursue it, I am quite active I spend a lot of time being active in my job at least 20 - 30 hours of exercise and I don't over eat, I am trying to improve my diet. I'm just wondering if anyone else has been in this position where their BMI doesn't reflect their actual size and how it affected their pregnancies?

Even if you were very obese the midwife would not say that or blame you. They will be able to see you at your booking appointment and be able to address your concerns so don't worry about it

They calculate it so they can assess your risk of blood clots and pre-eclampsia. They won’t ask you to diet whilst pregnant!

BMI isn’t about reflecting size, it’s about reflecting height and weight, so it’s not inaccurate in that but it’s absolutely not the full picture. For the purpose of pregnancy your BMI is mainly relevant as a higher BMI increases risk of various things such as gestational diabetes, thrombosis, high blood pressure and other things. The point of the BMI check is essentially so that they know you may be at an increased risk of these things so they can take extra precautions to ensure that you’re as safe as you can be and that they are as prepared as they can be to help you.

It’s not (or shouldn’t be) a stick to beat you with, try not to worry!

I had a BMI of 32 at my booking appointment and very little was said about it. The only difference in my treatment was that I was given a higher dose of folic acid, on prescription, and that I was scheduled for a gestational diabetes screening later in my pregnancy (I didn't have it). Nobody will shame you for your weight they will just make a couple of small changes to ensure that they're looking out for you and your baby.

I'm sorry you feel that the midwife would tell you its your fault! How can having large boobs be your fault? They sound disproportionate to rest of your body!

Despite the weight coming from the larger breasts, I would think that if your BMI is in the obese category- its still higher risks. You have increased fat on the breasts, increased blood supply etc.

Have you been taking prescribed 5mg of folic acid and not the OTC 400mcg? Even IF you are classed as higher risk due to your BMI- why is that bad? Surely you will have more monitoring which I can't see being a bad thing- unless I'm missing something?

To be clear about my post... I had the screening, I didn't have GD

If a midwife fat shames you, you ask for a new midwife whether you’re a size 8 or 28.

They may put you in a higher risk category for all kinds of reasons you don’t expect and not even BMI, but your midwifery team are there to support you and safely help deliver your baby, not to judge you. Please don’t overthink it or worry about it. They’ve seen women of all different shapes, sizes and backgrounds come through their door.

Even if the midwife mentions BMI and/or ticks a box to say this puts you at higher risk of certain things.....so what?
All it means is you might get an extra appointment or scan etc down the line that you'll probably be grateful for.

They really just need to be sensible about how they use your numbers when it comes to the things where weight/bmi are important factors. For some things they will need to ‘exclude’ your breast weight but for other things that weight does need factoring in (eg for some drug doesn’t you need medications). It’ll get a bit dull, but you might just find you have to have a conversation about it every time a ‘weight influenced’ decision is being made.

My BMI was 30 when I got pregnant second time. No one said a thing about it. It just meant I had to have a diabetes screening and I think inject myself with blood thinners for 10 days after I gave birth. (I have heard if someone is really heavy they may decline water births due to the difficulty in lifting out of the pool in the event of an emergency but it doesn’t sound like this would be you. Please don’t worry, you may get extra monitoring due to possible slightly increased risks for you/your baby but no one should judge you or say anything unkind/rude about it.

I just want to share my experience which I really hope doesn't upset or worry you, but I do think it's important to share both sides of experiences. I'm similar to you, short with 34HH bra size pre pregnancy and they haven't stopped growing. When I had my booking appointment I was told I was 0.5 into the obese category and recommended to have the GD test, which I expected, but also to start amending my diet to lose some weight. At my next midwife appointment she actually told me I need to join slimming world to loose weight. I was absolutely distraught (previous bad experiences on slimming world were triggered). I told the midwife firmly this isn't the time to start disordered eating and I would only take advice from a qualified dietician and if I felt it necessary.

I guess my point of this is, some midwives will push dieting and tell you you're obese and I really hope you don't experience what I have. But if you do, stand strong and answer back. I also asked to never have the midwife who told me to join slimming world again.

Us mums have got to advocate for ourselves!

My BMI was about 30 on the dot and was for my previous pregnancy too - nothing is said about it, they just log it, decide if to give you the gestational diabetes test or a higher dose of folic acid but they don't say 'because your BMI is obese' they just say it.

BMI is a metric, not a health condition in and of itself. I have high BMI and yet on every test that they have performed I am well within the normal limits. I have stayed active in all my pregnancies right up until delivery. You will probably be offered extra tests and monitoring compared to if your BMI was under 30, but you can choose to accept or decline this. It's your choice. Personally, I chose to accept the extra tests and monitoring because I would prefer to have a fuller picture of what's going on. It's also completely your choice if you want to have things like a home birth or use the midwife led unit. They can advise against these things, but cannot legally stop you accessing them (although they will make it sound like you're not allowed). This is also the case with a c section and induction. They can offer them, but cannot enforce that you accept. You also have the right to a c section if that's what you want.

The book Plus Size Pregnancy by Dr Sara Wickham is a brilliant resource if you want to find out more about the research around raised BMI in pregnancy and your rights. She also has lots of resources on her website.

How do you wear size 12-14 tops with JJ size chest?
If that's 30JJ, the boobs have to be 44".
44" boobs would mean OP needed size 16-20 tops most typically.,